HomeMy WebLinkAbout840 VICTORIA ST - Building PermitsOWNER
e
ROUGH PWMBING
PROP. $WR. UNE �
SPRINKLING SYSTEM
UNOERGROUNO
ROUGH WIHING
TRENCHES �
,u BONO BE�M [� STE
�'I SMEATNING
roFqAME AND FLASHING
'7 LnTNING — IN n 1
C PLASTER.BROWN CO�T
ri
STA��CTURAL, FINRL
�F VG, VENT., REFRI
PL..�aBING, FINRL RND
(� EI.ECTAIC. FINAI
BUILOING. FIN4L
CON�ITIONING
AND A.C.. FIN�L
DATE 10/13/80
BUILDING PERMIT N0.
SUBCONTRACTOR
OWNER ORT, LUDtdIG & JUEL . v � DATE i-11-55
JOBADDRESS 840 Victoria BUILDING PERMIT NO. 819
GENERALCONTHACTOR Ocmer-Builder VALUE $ 9(70.OQ
LOT 9 BLOCK TRACT 18%�2 Private Garage
GRJUP J TVPE V ZONE ILl FIRE DISTRICT (j3
PERMITS ISSUED
iNSPECTIONS DATE SUBCONTRACTOR
. _ ___ __ � . DATE � NUMBER
D
Plumbing, Rough to Slab
Temporary Pole
Wiring, Rough
Heating, Rough
Heating, Final
Sewer
Septic Tank or Cesspool
Lathing
P' ring
� Pl��.�bing, Final, Fi�ctures
Plumbfng, Final GasTest
Wiring, Final
'Occupancy
Forro 210 G-H lbf 1&69
PH0.IFCT�DOHESS: (;qO VICTORIA $T
OWNFN'SN�ME: CITY OF COSTA MESA
ROOflEBS: 77 FAZR DR 4TH FLOOR
C.M.
�flLMIENGINEER:
�ooxesa:
aea.xo.:
UNR:
uxrt:
���E� POt40NA VALLEY EQ[1IPME1dT i 714 ) 591-7879
�ooness: 11532 EAST END AVENUE
CHINO CA 91710
IILENSEO CONTM4TON DELUM710N: I �ereGy atfiim that I am 6cenceG unGer D�� a� Ctupter 9(mmmendnp wit� Secikn
7000) ol Didsion 3 af �M Business anA Prolesslons Ca�e, anC ikense is in iNl lorce an0 etlect.
cir uc. 0 9� 6 7 4 sten uc.: 417 2 9 2 �� �21� �) �
. oate: �_� iv=g�% Si9nature: CP.v✓�,.
WOBNEHS'LOMPFN311TIONOELUIUITION: IAere ani t naveaceninwteotcauem oseua oraceNnwrooiworkers
Compensation Insurance, or a cerlifleU coDY ��ertol�Sectm LaG. L�.
raucrno.: 1030869-89 ���*E 09/15/90
camvaxr: STATE FUND
��] Certife0 coDY is hereUy Iumis�eC. � Certifie0 coOY a wiM the cRy BuilUinO �sba �
c
�ate: � � � — � v ApDlianC ' �
IXEMPIION FNOM WOPIfERS' COMPENS�TION DECLAMTIO ' secum �reeU �nt Ee mmpletW il tlq pemit' ane AUMreO (f10D) or kss�.
i ceniH ��� in tne ce�ormanca af Ne woA tor wNch ttus it issueU. I shall not empby iny persan in any manner so a5 to Eecome
suEject to IAe Workers' Campemation Laxs at Calilortua. �
Dale: SIO��urt:
NO71tE: Ii, alter maNnp Ihis Uedaration. you StaulE bemrrc subjett ro tAe Workers Compe�satlon DroNsbns oi Na LaEor
CaEe. you must IOMviitn mmpty wi�� suc� D���s w Uis pemut 5ha0 he EremeE'iewke0.
CONSTRUCTION LENOING IIOENCY: I IrertOy att'um Wt ihere is a mmt�uction IeMinq apency iw Ihe pertormazrca oi Ue work for
whic� tAis permil is ixsue0 (�On 3W7. Civ. CI. .
lFNOEfl:
'' �DOflESS:
OWNEB BIIROEP OECUMTION: t �ereW atfirm WI I am exempt hom tM Convanori Stata Liceme Law lor IM IMowinp reasan
(Section 7031.5 Business anE Prolessio�l CaOe: My dry oi cowry whicl� repuires a cermit to wnstrucl, alter. Imprave, Uamollsn, or
repar arry SVucture, D�< <a ���• ��eGw� � aPD�^� �ar wM permn ro lile a sipne0 statement Rwi txJslre is IkenSeE
pursu�nt Io tna provlslons ol tM ConVactors' Sute Liunse Law (Chapter 9(commencinp wlin Sectlon 7000� ol OlWsion 3 of Ne Business
ana Professons CaOe) ar Wt Ae/she is eaempt Nuetmm ana ttx Gasis lor the a0ro� ezeino�� M'/ �+tlon ol Sectlon 7031.5 by
any apDllunt for a Dermlt wElecis Ue applkant to a civil penalty ol wt more ttun INe �unUreO tlollars (I500�.
I, az awner ol IAe properry or my emplayees wit� xapw az tneir sola wmpensa0on, wlll Oo iha work, anE the
0 slmcNm I5 nol ImeMeE w ottere0lor sale (Satbn 7071. B�dness an0 Pralessiwwl COEe: The Contnctors' SWte License Law
Uces not apply lo an ormer oi a properry wM OuilOs or imDroves thereon, an0 wlio doas such xroA himsell/Aersall or t�roup�
his w her own employeu, DroviEeO Ilut such imprwements are not IntenOeE or oHeraO lor sale. II, Mwever ihe OUJUInp or
imD�ovement is solE vAtMn one year ol campletlan. t�e oxner wi0 Aave tM hurUen ot pmNnp hUs�e AiE not builG or ImD�a�a
for Ue ourpose ot sale).
�I, az owner of Ne D�aDerty, am exUuslvety coniractlnp wii� IicensaE comradors to wnslmci t�a pro�ect �Sectlon 70/A, 9usiness
anO Pmlesslons CoOe: The Conlractors' State �icense Law Oau not appy to an mmer al pmperryx1p W Ids or Improves tMrean
I an0 who coniracts lor suc� O�ol��s vnt� a coniractor(s) license pursuant to tAe Contractors' Sule License Law�. 1 am aware
Wt Drool ol IMIr Warker's Compensa�on InSuantO sMuW he D�� Io me.
� I am exempt unEer Sectlon; B. 6 P. C.
lor tAis mamn:
Date: Q+mer.
I Oo �ere0y caniry Wt I am aware al an0 underswM I�e repuiamefrts nt Calitomia Healtn aiM Sahry CoAe Sections 25505, 25533, anE
25534 anE tMt I or any luWra OuiIWnO occupant wOVwill not (drde one) neeE ta mmpy wiN saitl state co0a anO IAe repuiremenU lor a
permit lor constructian ar maEifiwtian Irom IM N'r�i a4ry ManaAemem qsvict. Pe5lGentlal corawctim appGwtlore are exempt Irom
tnese Orav'aia5.
Date: Appficant:
I �ereCy ceNy �hat I Aave raE Nh apd��� �O state Itut tAe aEove in�wrtutioo is cwrat. I aprea Io compty witn all pry an0 wunry
ortlinancesaMsutelawsrzptuptoOuWhiparrsrnc7ionaM�ereO omnreWesenutivuafNrsclymeMerupmNeaOouammfioned
property � irapectbn purpmes. `
(
I Date: d S'ry�wWre: �
Driver's Liunu or SoNal Seanry x: ' �'.
1B11J8 W�Ite—Buikiip: Oreen—Cope Enlorcartrent: Cenary—Applicani: Pink—Ravanue: GdOanroO—Aeaasaor
CITY OF COSTA MPSA — SUILDING PERMIT PERM NO: BP 048260
PERMIT NO: BP 048260 PLAN CHECFC NO: N� GOVT: Y SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU STR PURPOSE: DEM
JOH DESCRIPTION : DEMO RESID FOR VICTORIA STREET WIDENING SQ FT:
CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000.00 GROUP OCC: R-3 /
COMMENTS: DEMO & SEWER CAP
�r�t�t?t�x--x rt*��*�?t�x������-��tt�lt��l�itxxx�**ar�l��t*�tit�t��t*�t#�t�t*it*it�*-x*i�-���i�-��*�t ��it��t����r�t�x�it****it�x� *�lt�� k+r�rt*
Z O N I N G R E Q U I R E M E N T S
S E T B A C Ft S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42220311 ZNE; REF NO: �
PLANNING NOTES>
>
iE'}.� jE'k iE #�ElE iE if !E iElt rt?E fE ff 1t if i! ik k iE iElt iE iE if i:� if iE it k 1k if if iE �F �)E iF �E iE iE i4 ik!!!E �.h iE i! if !E if iE iQ iE ik ik if iF 1E iE iE if iElE iE iE if iF')E iE i(� if 3E iE iE if i(�
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED bY . DATE:
bUILDING APPROVED HY :
DATE:
APPLICATION ISSUED BY: �-- DATE;���L �— d
�t-l�i��t*�t?tit****xiti�iE*i�it*�titiF�Fg3FiFiFiF3F�iFiFi��F3FifiF�FiF�F xiF �f'iF'3FiE'i��"�'�iFiFg*it*�t****x�*�'�£"�iFiF'��F#*#
ii if 1E iE iE iE iE ik iE if iE?f iE ik iEl4 it if iE iE it jF dF iE ik i(� if if iE iE?E iE iE iE �E iF # iE iElE iE iE �f iF if iE 14 it iE it iE i(� k iF if # i(�!F if'lE iE if iE iE iE iE iE if iE iF �lt if # iE iF M if 1E #
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 25.00 2z5$
PLAN
ISSUE FEE 3.00
BUILDING-DZV-> P£RMIT ISSUE PLAN-CHECK
TOTALS----> 0.00 0.00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
bLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
SMIP/NON-RES
.50
TOTAL PAZD DUE
�, � � � , 0 � . � �
,00 OVER/SHORT: .00
SMIP/TOT GRADING PLAN—CHECK
iE iE 1E it iE i(� iE it ik it iE iE if if �lt it k!k 1k if # iE fE iE if it iF ik iE ik iE if iE it iE iE iE if iE M� it it iE if ik i(� 1k iE it iFi(.!t iE iF if iE k it it if i4 if 3f iF if !E �1t if i! iE iE iE iE iF ih if if it if
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T Z O N UNIT COST TOTAL COST
PLU 1 SEWER CAP / DEMOLITION EACH 2.00 2.00
END OF FEES
01 �QU66137—�OOdbi37 T C�T AQ
DATE: U7/26/9Q iirE: 09:31
CONSTRUCTION AND PLANNING � POOL ��.,PA
Date Inspector � Date Inspector
APPROVALS Permit # ` _ / , APPROVALS Permit # �
1. Temporary Electrical Service br Pole L� 52. Pool & Equipment Location �
. �
Q, $oil Pipe-Undrgrnd. _ � 53. S[eel Reinforcement "
3. Electrical Conduit Utility-Undcgrnd. �� 54. Forms ��
4. Electrical Conduit-Undrgrnd ^ � 55. Electrical Bonding '�
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �
8. FOundation . "'� r' 59. Gas Pipe, O Undrgmd., Test - �
9. Water Pipe�Undrgrnd. � `Y" 60. Backwash Lines,P-Trap, O Undrgrnd. �C
10. Structural Floor System 61. APPROVAL 70 DECK
11. Properry Sewer Line & Hou3e"Connection �: 62. Backwash & Receptor-Final :�
�
�2. SQ'''�e� CaP � ,/f��fj £ 63. Heater & Vent-Final �
13. ROof Drains ` j �'
64. Plum6ing System � Final `1
i
14. Rough Plumbing ;;" �_' 65. Electrical�Final 2%/
15. Rough Electrical-Conduit ,-, r 66. Solar SYstem-final �
16. ROugfi Elearic Wiring � . 6�. Fencing & Access ApProval
17. ROugh Wiring Sign 68. APPROVED FOR PLASTERING
18. ROugh Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINA�
19, ROugh Heating & Air Conditioning FIRE DEPT. REQUIREMEN7
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas OOiI
23. Gas Pipe�Rough & Test 72. Underground flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hyclro
26. T-Bar Ceiling (Structural) & Monocoat 75. Ory Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77, FIXED SYSTEM FINAL
29. Insulation 7$, FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster 8rown Coat 79. FINAL INSPECTION
32. Electrical Power Meter•Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy .
37. Final Factory Fireplace �
F
38. Final Plum6ing �
39. Water Service-Final
40. Gas Service-Final '
41. Solar pomestic-Final
42. Backflow Preventer
43. Ba[kflow irrigation
44. �a�dscape Irriqatio� SVstem
. 45. Sound Attenuation
46. Handicap Regulations
47, FINALSTflUCTURE&BUILDING
48. FINAL PLANNING ..
49. Electric Release to Edison .,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
.� COSTA MESA BUILDING•SAFETY DEPARTMENT pPPLICATIONtF�H�3'RIfWQll3R8� PERMIT 36•
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626 -- --
REC PERMIT ��f
For Applicant to Fill in Completely — Use Ink Only `
ADORESS O A'P' N�' 1 �L�O� — Z
OWNEROR / �V ,• ADDRE55 � � S �
TENANT y
UNIT OR
MAILING �_ SPACE NO.
ADDRE55 �G O A
TR.N .� LOT BLK.
TEL.
CITV E No. 70
ODNSrRUCT�aN NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH � w �� �
OWNER (filL��'7'
AODFESS VALUE
ARCHITECT TEI. USE o- S Z Q9O
OR ENGINEEH A
ADDRESS ZONE ` TVPE V GROUP �3 M'
CONTRACTOR ByPROVED DATE IO � �f7
ADDR E55
TEL.
CITV NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. LIC. NO.
SIZE NO.OFBLDGS (FROM�/ TREET)
OF lOT NOW ON LOT M� FT.
USE OF �
EXISTING BIDG.
Separate permits are required for � si ,� Fr. ��•
etectric, plumbing and hea[ing work: .
REAR FT. 1
USE OF BUILDING AND WORK TO BE PERFORMED PI_P.NNING ACTION
pATE
�� APPROVED
� t ��D �O ` �
I �eraby ecknowledBe that I �avo roatl this appilcation ond rtate
that tha ebava Informetion Is correct antl apree to comply wlth � �
ell laws reBulatinp buildine construcNon, nnd I shnil not employ �/
any person in vlolation of the wo�kman's compensetion lewa ot
Me Staie of Californle.
I hereby certify that I am prooarly Iicensetl es e<aniractor undar � S�. FT. �
the Staie of Calitornla Business entl Frofessiona Cotle, Dlvlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and ihat such licenses are in tull force ond affect, or I THE PURPOSE OF ESTABL6NING A PERMIT FEE ONLV:
am exempt irom She provtsionsof thaState of Calltornla Buainass VALUATION
anA Profezsions Cotle, Division 3, Chapter 9. PERMIT FEE E , p0
Sip^ature of / PLAN CHECK E Z O�
Permittee $ 2 ��% TA% E O�S�
or ! / v
Authorized ABen Date TOTAL PAtO S�
50 7Ir
7
m
e
Y
m
m
0
f
u
\
Co�ta Mesa Building Department ��
� 771 EAS7 20th STREET
� COSTA MESA, CALIFORNIA
FOR APPLICANT TO b'ILI. IN
Address T!� 1 C t R; t F}
Costa, Mesa, California
Nearest r /�
Cross St. �� E �f �<7 � /� B
Owner �- i� ��JG R�(/�L. E//VT A
Mail
APPLICATION FOR PERMIT
BUILD�ING '
FOR Ok'FICE USE ONLY
Addresa `T' U l C T�/C� � Nearest
City C�.57ei !�'/�%S� N��'� �EQ�S Zone S�
Architect or Lic.
Address
Size of Lot (p
Use ot
Exfsting Bldg.
Setback Linefr
Center of Streel
DES
New I
Repair I
Building ���
Sfze
Exterior Wall
Coverin8 �S/�
Use oi New i
I: [71
�1� /i(9,I NowonL t� �
No.of / No.ot
D/%�%� Familiesb Rooms
o�I .> ,Rra�Yard A`�/
�i i
Demolish
� IYp.OT �
Raoms Stories
Roof (y OM GOSiT/G.
n.,,� Covering SN//VIeL.�C
�'i9
Date Issued
/- ii -s S`
Costa Mesa, California
APPROVAI.S
�.ion Loeation Inspecto
:, Materials,
-Pinning
Fire Stops,
Iq. BO�t9
I hcreby acknowledge that I have read this Appiication Lath. Int.
and state that the above is correM and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
building rnnstruc '
Signatureof • Plaster,lnt.
Permittee
Plaster, Ext
Authorized Agt.
Masonry Reinforced
Valuatfon Permit Fee $ G • �
s %/ Q� Plan Check $' e O Bond Beam
�� Total
Fee $ � � � FINAL
. . . . . . ;.�e�ar�� . .... .. . � '.�rr•.�_. ' � . � p _ . ..
.3�is't i • ' G "'-� �
, � ��
u '. -
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c
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a. . r."', . . .
� a
_ a - - - - ` - . , .
a
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A �
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. � i t+ i � ' , ,qT � ` 'G \ 4. •� — . .. , � n _ _ < . . .. . � .... �
�4
� .. ,�... . .�. , .
;' '_.. . • • . . r:o. - .. . . ., r. �
� — .-. ,� � ' .. . . .
� 5 � Street •.; ,� � .. . . _ . ,' .
�ff'',! ;�i�i:i � . . . �n. � .
, , rr.ar rraiv ,� # � ; -- - - . :� : � .� : � _ . ,_ . _ -. : . _: _ .
�; Show locatlon and distances from '•'�' '�� _ � - � �'�'• ' - `
� propeHy line and between buildings. ' .;;�, - . , . ��•,- � �
� _
f- . � ' ' .-r.' � � �
•1•y_'.' ____�. .'_' . . " ... .
' .. . . . . . . , . i.'
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... .. ,nn.., .f1:
_. .. . _ " . ."" _ _'_ _ "' ._'___ '
' . . . �.. . . , - ' . '
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, " I' ". ' _' ' \ .
i. . �
"'— '" ' ' ' " " """ _' ' . "— _' '
__' " _ . ... .. . �R
APPLICATION FOR A BUILDING PE"91T
Tratt 1��Z ei«k �o� BUILDING PERMIT NO. �rmii No. �
a
�[ �e�A,/ Plumbin9 •
Atl'tlr�ess g-(� ��L' � O�� V�S�•' �"ff— Rermi[No, m
Cross /� �D �+ �� Methaniral a
�V 1 !� n/` � w1 � Pormit no.
Arra Streel � �.�r,i l:..0 1\ A
Ownar^ � � C� � A��v�` A� Typa oT Projech ❑ Now ❑ Altar ❑ Atltlillon �
Atltlross � � (��v' �/ � . ❑ Repalr ❑ Conwrt ❑ Demo ❑ Occupancy Pml.
C/V �Tl C�IT'� �6� l'��`/O/O SuP. Dist./
Cily Zip ne A•P• InsD. P.rea
A�Chitott/ ZOnO $PI. PTt. No.
Da5i9nOr License No.
$GtEatks P/L Fron[ GlSt. $l�eet Wltlth
A�tlress
artls o l 9 ear
Qty ZID 7�one
ve o . o g . .
Engineor Llcenu No.
� Par ng paces aqu ra ov e ovare
a Atlaress
m Cit ZID Phona Struct No. of No. ot
Y Height Storles Famlly
� LICENSED CONTRACTOR'S DECLARATION aark Fan vos Fea
� I t�ereby ufflrm that 1 em licensetl untlar provisiona of Chapter 9 Requiretl No C.T. Racaipt
L (commencing with Sucilon 7000 of Division 3 of [he Buainess and Zoning APpraved BY: Data
Protessione Codo, antl my license is in full foreo and a4tactl.
2� Licanao Claa Licansa NumGar
T �ate Conxmctor Misc. �
E Addrass aoPosetl Use
LL
Ci[y end Zip Phone of Structure
H CONSiHUCT10N LENDING AGENCV
� I heroby nftirm that 2here is a construction lending a8eney for the
a parformenca of the work tor which this parmi[ is issuetl (Sec. 3097, Occ. TyOe COtle
Civ. C.). Cldss COnii. Vedr
y Lender's Nama
� Lender's Address USE/OCCUPANCV SIZE SQ. FT.
'� OWiJER-BUILDER DECWRATION
r I hereAy effirm thet I em eaempt from the Contractor's License Lew 1�
� • or the following reawn:
� I, as Ownor of the prOperty, or my employeas wi[� weBas as their 2.
� solo compensotion, will Eo ��e work, and the attuctura le not
,t„ Inrontletl or oftoretl }or mla.
3.
� ❑ I,' as owner of the property, am azelusively eonttaetinB w��h
Ilcansetl tontla<tofa t0 Conrtl�[t the projac[.
d ❑ I u�m� o�xep�npp[ o�n,dor Sec. B&PC^�or this reasDn a•
aDate�L=LLGCOwner }L ` $��t-A\-- n►
E WORKERS COMPEN i�TION DECLARATION Tatai Valuatlon
� I hereGy aftirm that I �ava e carUtieata ot eonwnt ro wl/-imuro, Eneroa[hment Pe�mlt ReqWretl ❑ V!5 ❑ No
or a cerUflcate ol Workan' Compensntion Inmranca, or a certifletl
c copy tM1orooi. GraEing PmL G�atling
� Policy No. Compeny ReQuiretl ❑ Yos ❑ No Pmt. No.
�a ❑ Certified copy ia haraby furnishatl. Rou9� Gratling �
a ❑ Cortiliotl copy Is fllad with O�enge Counry, EMA. m
Q App�OveC by: Date
Deto Applicen[ 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSA710NINSURANCE Z
(Thb secNon noad not be comolateC if purmii I; lor 5100 or lessl. �
I cerWy that fn Mo performanca o( the work for which this pu.mit k Q
isnuatl, I shail not omploy any parwn in env mannar fo ae �o bocoma PERMIT FEES �
subjact to the Workeri Compensation Lewz of Gali(ornia. .
Dot� Applicant
NOTICE TO APPLICANT: If, after meking this Carti�icato ot Struttural E Plan Chetk 5
Examption, you shoultl becoma :uE�ect to the Warkeri Compansetion
provisions of t�o La�or Code, you must fo�thwith comply with sueh Electrifal S SPecial s
provisiana or thi� permit shell be tlaematl ravokatl. Invest.
I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO P�umbing S
COMPLV WITH ALL COUNTV OROINANCES AND STATE LAWS
RELATINGTO BUILDING CONSTRUCTION,AND HEREBV AUTH- Mechaniral E
OR12E REPRESENTATIVES OF TH�S COUNTV TO ENTER VPON
THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- q�e-Gratle
POS^ES. � l^^ (�,�� �_ ��� cx' Inspection E
`� `�' �"""`�^""'M1� \Ol� ^ " Pre-Gratle Permit
SiBnat e of Appliwnt or Agent Oate Rec. No. S Issue s
�1oS� CoYA'����pg
Princ ApplicanYs/Agan['s Neme
All s ces within this box musc be complated to process P�an Issuance
� Check By: AOProvetl:
CMF 0335-46 (BU-28� rov. 6/80